Trowbridge Surgery

Updated 17 June 2016

The practice is located in the London Borough of Hackney. It is one of 43 GP practices in the City & Hackney CCG. There are approximately 5,500 patients registered at the practice, which is situated in an area mostly made up of houses and blocks of flats, there are also local shops and supermarkets nearby. There is limited local parking as permits are required, though the area is served by buses and a local London Over ground station at Hackney Wick.

• The practice is part of the AT Medics Limited group of 24 practices across London run by GP directors.

• It has an APMS contract with the NHS to carry out the following regulated activities: Diagnostic and screening procedures; Family planning; Maternity and midwifery services; Surgical procedures; and Treatment of disease, disorder or injury.

• There is one male GP director, and two salaried GPs, one male the other female, and a male locum GP who works Saturday mornings. There is also a Director of Operations working a whole time equivalent (WTE) of 0.5, an assistant practice manager (WTE 1.0), a female non-prescribing practice nurse (WTE 1.0), and four reception staff (working a combined WTE of 3.8), including one who is also a qualified phlebotomist. The GP director works a whole time equivalent of 0.2, while the salaried GPs work a WTE of 08. And 0.7 respectively.

• It is a teaching practice for F2 doctors (F2 is a grade of medical practitioner undertaking a two-year, general postgraduate medical training programme which forms the bridge between medical school and specialist/general practice training.) and there is currently one F2 doctor with the practice.

• The practice is open between 8.00am and 6.30pm Monday to Friday, and from 8.50am to 12.00pm on Saturdays. Appointments are from 9.00am to 12.00pm every morning and 3.00pm to 6.00pm daily. In addition, there are: emergency appointments from 8.00am to 9.00am Monday to Friday; telephone consultations are available between 9.00am to 10.45am on Tuesdays, Wednesdays and Thursdays; there is a duty GP available to see patients from 8.00am to 6.00pm Monday to Friday.

• When the practice is closed patients are directed to call either 111 or to their out of hours provider City & Hackney Urgent Healthcare Social Enterprise (CHUHSE).

• The practice is located in the most deprived decile in England. Life expectancy is below average for both men and women. Of the patients registered at the practice 55.0% are white, 24.6% are black, 6.3% are Asian.

Updated 17 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Trowbridge Surgery on 14 January 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

In 2013 the practice had achieved a Royal College of GPs quality practice award. At that time it was one of only twelve practices in London that had earned this award, which recognises the commitment of the practice and its staff to providing high quality care to patients.

The areas where the provider should make improvement are:

• To lock the vaccines fridge or locate it in a locked room to ensure that its contents are accessible only to authorised practice staff.

• To review PGD policy in relation to national guidance on the production and storage of PGDs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 June 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff and GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 97.37% of patients on the diabetes register, had a record of a foot examination and risk classification within the preceding 12 months compared to the national average of 88.3%.

• 97.62% of patients with diabetes, on the register, had had influenza immunisation in the preceding 1 August to 31 March compared to a national average of 94.45%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 17 June 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• 92.34% of patients with asthma, on the register, had had an asthma review in the preceding 12 months (national average 75.35%).

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 82.59%, which was comparable to the national average of 81.33%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, and health visitors.

• The practice provides in-house screening for sexually transmitted infections and IUD fitting.

Updated 17 June 2016

The practice is rated as good for the care of older people.

• The practice had a small population of 160 patients over the age of 65.

• It offered proactive, personalised care to meet the needs of the older people in its population. For example it held monthly multidisciplinary team (MDT) meetings to support older patients and to help them to avoid hospital admissions.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Patients over 75 years of age who had not been seen for three years were offered over 75s health checks and were opportunistically screened for dementia.

• The practice participated in the local enhanced frail home visiting scheme that provided proactive care to elderly frail housebound patients.

Updated 17 June 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• It offered appointments on Monday to Friday between 8.00am to 6.30pm and on Saturday mornings as well as telephone consultations to enable working patients to get appointments.

• The practice also supported out of area registration for people working in the area.

Updated 17 June 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 91.3% of patients with schizophrenia, bipolar affective disorder and other psychoses had had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (national average 88.47%).

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 17 June 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.